title: Evaluation of paediatric nursing-sensitive outcomes in an Australian population using linked administrative hospital data.
abstract: BACKGROUND
  Research into nursing-sensitive outcomes using administrative health data has focussed on hospitalised adults. However, we developed algorithms for the identification of 13 paediatric nursing-sensitive outcomes, which we seek to examine for clinical utility. The aims were to determine the rates of paediatric nursing-sensitive outcomes in a Western Australian hospital and ascertain sociodemographic and clinical characteristics associated with a greater risk of developing nursing-sensitive outcomes in hospitalised children.
  
  
  METHODS
  A retrospective cohort study used linked administrative data of all Western Australian children ≤18 years admitted to the only tertiary paediatric hospital in Perth between 1999 and 2009. Rates per 1,000 hospital separations and per 10,000 patient days were calculated for the following nursing-sensitive outcomes: lower respiratory tract infection (LRTI), gastrointestinal (GI) infection, pneumonia, sepsis, arrest/shock/respiratory failure, central nervous system complication, central venous line infection, infectious disease, pressure ulcer, failure to rescue, surgical wound infection, physiologic/metabolic derangement, and postoperative cardiopulmonary complications. Poisson multiple regression models were fitted to estimate rate ratios (RR) and 95% confidence intervals (CI) for suspected risk factors.
  
  
  RESULTS
  Linked records of 129,719 hospital separations were analysed. Rates ranged from 0.5/1,000 for pressure ulcer to 14.0/1,000 hospital separations for GI infections. Age was significantly associated with the risk of a nursing-sensitive outcome: compared with adolescents, toddlers had greater risk of GI infection (RR 9.89; 95% CI 6.24, 15.69); infants had 7.74 times greater risk of LRTI (95% CI 5.11, 11.75), while neonates had lower risks for sepsis (RR 0.26; 95% CI 0.08, 0.90) and physiologic/metabolic derangement (RR 0.12; 95% CI 0.04, 0.35). The risk of surgical wound infection was 7.78 times greater (95% CI 5.10, 11.86) for emergency admissions than elective admissions.
  
  
  CONCLUSIONS
  Seven of the 13 defined nursing-sensitive outcomes occurred with sufficient frequency (>100 events over the 10 year study period) to be potentially useful for monitoring the quality of nursing care. These nursing-sensitive outcomes are: LRTI, GI infection, pneumonia, surgical wound infection, physiologic/metabolic derangement, sepsis and postoperative cardiopulmonary complications. When used for quality improvement or to benchmark with other agencies, data need to be adjusted for, or stratified by age and admission type, to ensure equitable comparisons.
authors.affiliation: School of Population Health, The University of Western Australia, 35 Stirling Hwy, Perth 6009, Western Australia. sally.wilson@curtin.edu.au.
authors.forename: Sally
authors.initials: S
authors.lastname: Wilson
authors.forename: Alexandra P
authors.initials: AP
authors.lastname: Bremner
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Hauck
authors.forename: Judith
authors.initials: J
authors.lastname: Finn
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D010371:Pediatric Nursing / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014904:Western Australia / Q000453:epidemiology